title: Superficial versus combined (deep and superficial) cervical plexus block for carotid endarterectomy.
abstract: It is not clear if any technique of regional anesthesia for carotid endarterectomy has an advantage over another. Therefore, we analyzed analgesic efficacy side effects and complication rate in patients undergoing carotid surgery either under combined (deep and superficial) or superficial cervical block alone. Data on 324 patients that received either combined (n = 107) or superficial (n = 216) cervical block were prospectively analyzed. Data were collected on the intraoperative Verbal Analog Score (VAS), arterial pressure and heart rate. Analgesic efficacy was additionally assessed by the dose of supplemental 1% lidocaine and fentanyl and time before the first analgesic was administered at Intensive Care Unit. During surgery, VAS was slightly higher in the superficial group (median 0.6, range 0-3.9) than in the combined group (median 0.4, range 0-2.4; p < 0.001). The median supplemental lidocaine dose during the operation was higher in the superficial block group (2.4 mg/kg, range 1.1-3.5) than in the combined group (2.1, range 0.5-3.4 mg/kg; p < 0.001). Supplemental fentanyl was also higher in the superficial block group. There were no between-group differences in the time before the first postoperative analgesic, postoperative VAS and block-related complication rate. Accordingly combined block provided a slightly better analgesia during the surgery which was probably clinically irrelevant. There was no difference in postoperative analgesia and hemodynamic stability. So far, this is the largest prospective study in which superficial cervical block was found to be as efficacious as combined block which is associated with a considerably higher risk of complications.
authors.affiliation: Department of Anesthesiology and Intensive Care, Sestre milosrdnice University Hospital, Zagreb, Croatia.
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Ivanec
authors.forename: Branka
authors.initials: B
authors.lastname: Mazul-Sunkol
authors.forename: Ivo
authors.initials: I
authors.lastname: Lovricević
authors.forename: Zdenko
authors.initials: Z
authors.lastname: Sonicki
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Gvozdenović
authors.forename: Katarina
authors.initials: K
authors.lastname: Klican
authors.forename: Helena
authors.initials: H
authors.lastname: Krolo
authors.forename: Tomislav
authors.initials: T
authors.lastname: Halapir
authors.forename: Zdenko
authors.initials: Z
authors.lastname: Novotny
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002572:Cervical Plexus; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*